COVID-19 Results Briefing

Pakistan
December 15, 2022
This document contains summary information on the latest projections from the IHME
model on COVID-19 in Pakistan. The model was run on December 15, 2022, with data
through December 12, 2022.

There are surges in many parts of Pakistan due to the high percentage of susceptible
individuals in the population. This is due to low vaccination rates, waning immunity from
vaccines and previous infections, low mask wearing, high mobility, and seasonality of the
virus. We estimated that about 99% of the population in the country have been infected by
SARS-CoV-2 at least once. The detection rate remains very low in the country due to
limited testing.
The change of policy in China away from zero-COVID will result in a rapid rise of infections
and deaths, Clearly, the policy environment in China, with a population with lower
immunity than essentially all other countries, will likely determine the global epidemic in
the next four months.

Our model projects 31,000 cumulative reported deaths due to COVID-19 on April 1. We do
not project stress on hospitals in Pakistan in the coming months from COVID. However,
reports of increased infections of RSV and influenza in many parts of the world combined
with COVID-19 may pose stress on the medical system.

Our reference scenario does not include the emergence of new Omicron subvariants. The
emergence of a new variant with immune escape and increased severity is the most
concerning possibility. Even without increased transmissibility, a variant with sufficient
immune escape could replace Omicron, and increased severity could return the world to the
much higher death rates of 2021. Continued waves of Omicron subvariants that increase
immunity levels in the population may actually reduce the risk of such an event.

From a policy perspective, global surveillance is critical so that the emergence of a new
variant that is more severe is identified early, allowing various governments to prepare and
respond. Global surveillance, however, is becoming less intense. The best measure of
transmission now is hospital admissions, but there is less reporting, not more, of COVID-19
hospital admissions. Existing tools (vaccination, monoclonals, and antivirals) should be
widely available and will help mitigate the impact of COVID-19.

Current situation
• Daily infections in the last week increased to 358,000 per day on average compared to
308,000 the week before (Figure 1.1).

• Daily reported cases in the last week decreased to 73 per day on average compared to
81 the week before (Figure 2.1).

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• Daily hospital census in the last week (through December 12) remained the same at
1,100 per day on average compared to the week before.

• Reported deaths due to COVID-19 in the last week increased to one per day on average
compared to zero the week before (Figure 3.1).

• Total deaths due to COVID-19 in the last week increased to 11 per day on average
compared to six the week before (Figure 3.1). This makes COVID-19 the number 52
cause of death in Pakistan this week (Table 1). Estimated total daily deaths due to
COVID-19 in the past week were 19.7 times larger than the reported number of
deaths.

• The daily rate of reported deaths due to COVID-19 is greater than 4 per million in no
provinces and territories (Figure 4.1).

• The daily rate of total deaths due to COVID-19 is greater than 4 per million in no
provinces and territories (Figure 4.2).
• We estimate that 99% of people in Pakistan have been infected at least once as of
December 12 (Figure 6.1). Effective R, computed using cases, hospitalizations, and
deaths, is greater than 1 in five provinces and territories (Figure 7.1).

• The infection-detection rate in Pakistan was close to 0% on December 12 (Figure 8.1).

• Based on the GISAID and various national databases, combined with our variant
spread model, we estimate the current prevalence of variants of concern (Figures 9.1-
9.6). We estimate that the Alpha variant is circulating in seven provinces and
territories, that the Beta variant is circulating in no provinces and territories, that the
Delta variant is circulating in six provinces and territories, that the Gamma variant is
circulating in no provinces and territories, that the BA.1/BA.2 variants are circulating
in seven provinces and territories, and that the BA.5 variant is circulating in seven
provinces and territories.

Trends in drivers of transmission

• Based on self-reported mask use data collected in the COVID-19 Trends and Impact
Survey, an estimated 8% of people are projected to always wear a mask when leaving
their home. Mask use after June 24, 2022, is a statistical forecast.

• As of December 12, no provinces and territories have reached 70% or more of the
population who have received at least one vaccine dose, and no provinces and
territories have reached 70% or more of the population who are fully vaccinated
(Figures 12.1 and 12.2). 62% of people in Pakistan have received at least one vaccine
dose, and 59% are fully vaccinated.
• In our current reference scenario, we expect that 140.0 million people will be
vaccinated with at least one dose by April 1 (Figure 14.1). We expect that 59% of the
population will be fully vaccinated by April 1.

Projections and scenarios

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We produce three scenarios when projecting COVID-19. The reference scenario is our
forecast of what we think is most likely to happen:

• Vaccines are distributed at the expected pace. Brand- and variant-specific vaccine
efficacy is updated using the latest available information from peer-reviewed
publications and other reports.

• Future mask use will decline to 50% of the minimum level it reached between January
1, 2021, and May 1, 2022. This decline begins after the last observed data point in each
location and transitions linearly to the minimum over a period of six weeks.

• Mobility increases as vaccine coverage increases.

• Mandates will be reimposed at the maximum level of mandates in the post-ancestral
period once the death rate has reached an algorithmic minimum threshold of daily
reported deaths for a given location.

• 80% of those who are fully vaccinated (two doses for most vaccines, or one dose for
Johnson & Johnson) receive an additional dose six months after becoming fully
vaccinated, and 80% of those who receive an additional dose receive a second
additional dose six months later.

• Antiviral utilization for COVID-19 risk prevention has reached 80% in high-risk
populations and 50% in low-risk populations between March 1, 2022, and June 1, 2022.
This applies in high-income countries, but not low- and middle-income countries, and
this rollout assumption follows a similar pattern to global vaccine rollouts.

The 80% mask use scenario makes all the same assumptions as the reference scenario
but assumes all locations reach 80% mask use within seven days. If a location currently has
higher than 80% use, mask use remains at the current level.

The antiviral access scenario makes all the same assumptions as the reference scenario
but assumes globally distributed antivirals and extends coverage to all low- and middle-
income countries between August 15, 2022, and September 15, 2022.

Infections
• Daily estimated infections in the reference scenario will rise to 1,165,990 by
February 3, 2023 (Figure 16.1).

• Daily estimated infections in the 80% mask use scenario will rise to 625,170 by
March 2, 2023 (Figure 16.1).
• Daily estimated infections in the antiviral access scenario will rise to 1,165,990 by
February 3, 2023 (Figure 16.1).

Cases

• Daily estimated cases in the reference scenario will rise to 420 by February 19, 2023
(Figure 16.2).

• Daily estimated cases in the 80% mask use scenario will rise to 270 by March 15,
2023 (Figure 16.2).

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• Daily estimated cases in the antiviral access scenario will rise to 420 by February
19, 2023 (Figure 16.2).

Hospitalizations

• Daily hospital census in the reference scenario will rise to 4,960 by February 20,
2023 (Figure 16.3). At some point from December through April 1, no provinces and
territories will have high or extreme stress on hospital beds (Figure 18.1). At some
point from December through April 1, no provinces and territories will have high or
extreme stress on intensive care unit (ICU) capacity (Figure 19.1).

• Daily hospital census in the 80% mask use scenario will rise to 2,710 by March 19,
2023 (Figure 16.3).

• Daily hospital census in the antiviral access scenario will rise to 4,310 by February
19, 2023 (Figure 16.3).

Deaths

• In our reference scenario, our model projects 31,000 cumulative reported deaths due
to COVID-19 on April 1. This represents 260 additional deaths from December 12 to
April 1. Daily reported COVID-19 deaths in the reference scenario will reach zero by
March 4, 2023 (Figure 16.4).

• Under our reference scenario, our model projects 609,000 cumulative total deaths
due to COVID-19 on April 1. This represents 5,200 additional deaths from December
12 to April 1 (Figure 16.5).

• In our 80% mask use scenario, our model projects 31,000 cumulative reported deaths
due to COVID-19 on April 1. This represents 130 additional deaths from December 12
to April 1. Daily reported COVID-19 deaths in the 80% mask use scenario will reach
zero by March 27, 2023 (Figure 16.4).
• In our antiviral access scenario, our model projects 31,000 cumulative reported
deaths due to COVID-19 on April 1. This represents 220 additional deaths from
December 12 to April 1. Daily reported COVID-19 deaths in the antiviral access
scenario will reach zero by March 4, 2023 (Figure 16.4).

• Figure 17.1 compares our reference scenario forecasts to other publicly archived
models. Forecasts are widely divergent.

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Model updates
We have updated our reference scenario to assume that mandates will be re-imposed at the maximum level of
mandates in the post-ancestral period once the death rate has reached an algorithmic minimum threshold of
daily reported deaths for a given location.
For the foreseeable future, we will not be updating our model or producing COVID-19 estimates. These will
be the final briefing documents we produce until further notice.

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 Pakistan

Figure 1.1: Daily COVID-19 hospital census and estimated infections

6,000,000
Number of people

4,000,000

2,000,000

0
20

20

20

20

20

20

21

21

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N
Daily estimated infections Daily hospital census

Figure 2.1: Reported daily COVID-19 cases, moving average

6,000
Daily cases

4,000

2,000

0
20

20

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20

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Table 1: Ranking of total deaths due to COVID-19 among the leading causes of mortality this
week, assuming uniform deaths of non-COVID causes throughout the year

Cause name Weekly deaths Ranking

Neonatal disorders 4,804 1
Ischemic heart disease 3,527 2
Stroke 2,028 3
Diarrheal diseases 1,481 4
Lower respiratory infections 1,311 5
Tuberculosis 1,207 6
Chronic obstructive pulmonary disease 1,205 7
Diabetes mellitus 917 8
Chronic kidney disease 854 9
Cirrhosis and other chronic liver diseases 848 10
COVID-19 78 52

Figure 3.1: Smoothed trend estimate of daily COVID-19 deaths

3,000

2,000
Daily deaths

1,000

0
20

20

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N

Total Reported

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Daily COVID-19 death rate per 1 million on December 12, 2022

Figure 4.1: Daily reported COVID-19 death rate per 1 million

<1
1 to 1.9
2 to 2.9
3 to 3.9
4 to 4.9
5 to 5.9
6 to 6.9
7 to 7.9
>=8

Figure 4.2: Daily total COVID-19 death rate per 1 million

<1
1 to 1.9
2 to 2.9
3 to 3.9
4 to 4.9
5 to 5.9
6 to 6.9
7 to 7.9
>=8

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Cumulative COVID-19 deaths per 100,000 on December 12, 2022

Figure 5.1: Reported cumulative COVID-19 deaths per 100,000

<50
50 to 99
100 to 149
150 to 199
200 to 249
250 to 299
300 to 349
350 to 399
>=400

Figure 5.2: Total cumulative COVID-19 deaths per 100,000

<50
50 to 99
100 to 149
150 to 199
200 to 249
250 to 299
300 to 349
350 to 399
>=400

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 Pakistan

Figure 6.1: Estimated percent of the population infected with COVID-19 on December 12,
2022

<10
10 to 19.9
20 to 29.9
30 to 39.9
40 to 49.9
50 to 59.9
60 to 69.9
70 to 79.9
80 to 89.9
>=90

Figure 7.1: Mean effective R on December 1, 2022. Effective R less than 1 means that transmission
should decline, all other things being held the same. The estimate of effective R is based on the combined
analysis of deaths, case reporting, and hospitalizations where available. Current reported cases reflect
infections 11-13 days prior, so estimates of effective R can only be made for the recent past.

<0.87
0.87 to 0.89
0.9 to 0.92
0.93 to 0.96
0.97 to 0.99
1 to 1.05
1.06 to 1.11
1.12 to 1.17
1.18 to 1.23
>=1.24

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Figure 8.1: Percent of estimated COVID-19 infections detected. This is estimated as the ratio
of reported daily COVID-19 cases to estimated daily COVID-19 infections based on the SEIR disease
transmission model. Due to measurement errors in cases and testing rates, the infection-detection rate can
exceed 100% at particular points in time.

100%
Percent of estimated infections detected

75%

50%

25%

0%
20

20

20

20

20

21

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D

D
Egypt Iran (Islamic Republic of) Iraq Pakistan Sudan

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Estimated percent of circulating SARS-CoV-2 for primary variant families on December 12, 2022
Figure 9.1: Estimated percent of new infections that are Alpha variant

0%
1−9%
10−24%
25−49%
50−74%
75−89%
90−100%

Figure 9.2: Estimated percent of new infections that are Beta variant

0%
1−9%
10−24%
25−49%
50−74%
75−89%
90−100%

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 Pakistan

Figure 9.3: Estimated percent of new infections that are Delta variant

0%
1−9%
10−24%
25−49%
50−74%
75−89%
90−100%

Figure 9.4: Estimated percent of new infections that are Gamma variant

0%
1−9%
10−24%
25−49%
50−74%
75−89%
90−100%

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 Pakistan

Figure 9.5: Estimated percent of new infections that are BA.1/BA.2 variant

0%
1−9%
10−24%
25−49%
50−74%
75−89%
90−100%

Figure 9.6: Estimated percent of new infections that are BA.5 variant

0%
1−9%
10−24%
25−49%
50−74%
75−89%
90−100%

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 Pakistan

Figure 10.1: Infection-fatality rate on December 12, 2022. This is estimated as the ratio of COVID-19
deaths to estimated daily COVID-19 infections.

< 0.2%
0.2% to 0.39%
0.4% to 0.59%
0.6% to 0.79%
0.8% to 0.99%
> 1%

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 Critical drivers

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Sindh
Punjab
Khyber Pakhtunkhwa
Islamabad Capital Territory
Gilgit−Baltistan
Balochistan
Azad Jammu & Kashmir
Primary school closure
Secondary school closure
Higher school closure
Entry restrictions for some non−residents
Entry restrictions for all non−residents
Individual movements restricted
Curfew for businesses
Table 2: Current mandate implementation

Individual curfew
Gathering limit: 6 indoor, 10 outdoor

Mandate in place
Mandate in place
Mandate in place

(imposed this week)

Gathering limit: 10 indoor, 25 outdoor
Pakistan

Gathering limit: 25 indoor, 50 outdoor

Gathering limit: 50 indoor, 100 outdoor

(updated from previous reporting)

Gathering limit: 100 indoor, 250 outdoor
Restaurants closed
Bars closed
Restaurants / bars closed
Restaurants / bars curbside only

No mandate
No mandate
No mandate
Gyms, pools, other leisure closed

(lifted this week)

Non−essential retail closed
Non−essential retail curbside only
Non−essential workplaces closed

(updated from previous reporting)

Stay home order
Stay home fine
Mask mandate
Mask mandate fine

Institute for Health Metrics and Evaluation

 Pakistan

Figure 11.1: Trend in the proportion of the population reporting always wearing a mask when
leaving home

60
Percent of population

40

20

0
20

20

20

20

20

21

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Egypt Iran (Islamic Republic of) Iraq Pakistan Sudan

Observed Projected

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 Pakistan

Table 3: Estimates of vaccine effectiveness for specific vaccines used in the model at preventing
severe disease and infection. We use data from clinical trials directly, where available, and make estimates
otherwise. More information can be found on our website.

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 Pakistan

Percent of the population having received at least one dose (12.1) and fully vaccinated against SARS-CoV-2
(12.2) by December 12, 2022
Figure 12.1: Percent of the population having received one dose of a COVID-19 vaccine

0%
<10%
10−20%
20−30%
30−40%
40−50%
50−60%
60−70%
70−80%
80−90%
90−100%

Figure 12.2: Percent of the population fully vaccinated against SARS-CoV-2

0%
<10%
10−20%
20−30%
30−40%
40−50%
50−60%
60−70%
70−80%
80−90%
90−100%

covid19.healthdata.org Institute for Health Metrics and Evaluation

 Pakistan

Figure 13.1: Estimated proportion of the total population that is not vaccinated but willing
to be vaccinated as of June 24, 2022

0%
<5%
5−10%
10−15%
15−20%
20−25%
25−30%
30−35%
35−40%
40−45%
45−50%
50%+

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 Pakistan

Figure 14.1: Percent of people who receive at least one dose of a COVID-19 vaccine and those
who are fully vaccinated

60%

50%
Percent of population

40%

30%

20%

10%

0%
D 20

Ja 0
Fe 1
M 21

Ap 1
M 1

Ju 1
21

Au 1
Se 21

O 1
N 1
D 21

Ja 1
22

M 22

Ap 2
M 2

Ju 2

Ju 2
Au 2
Se 22

O 2
N 2
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Ja 2
Fe 3
M 23

Ap 3
M 3
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At least one dose Fully vaccinated

Figure 15.1: Percent of people who are immune to Delta, BA.1/BA.2 or BA.5. Immunity is
based on protection due to prior vaccination and infection(s). Moreover, variant-specific immunity is also
based on variant-variant specific protection.

90%

80%
Percent of population

70%

60%

50%

40%

30%

20%
21

21

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N

Delta BA.1/BA.2 BA.5

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Projections and scenarios

Figure 16.1: Daily COVID-19 infections until April 01, 2023 for three scenarios

Daily estimated infections per 100,000

6,000,000
Daily estimated infections

2000
4,000,000

1000
2,000,000

0 0
20

Au 0
20

D 0

Fe 0

Ap 1
1
21

21

D 1

Fe 1

Ap 2
2

Au 2
22

D 2

Fe 2

Ap 3
3
r2

2
r2

2
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2
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b

ct

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Ap
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Ju
O

O
Reference Antiviral access
80% mask use

Figure 16.2: Daily COVID-19 reported cases until April 01, 2023 for three scenarios

Daily cases per 100,000

6,000
Daily cases

2
4,000

2,000 1

0 0
20

20

20

20

20

21

21

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Fe

Ju

Au

Fe

Ju

Au

Fe
O

O
D

Reference Antiviral access

80% mask use

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 Pakistan

Figure 16.3: Daily COVID-19 hospital census until April 01, 2023 for three scenarios

Hospital census per 100,000 population

50

90,000 40
Hospital census

30
60,000
20
30,000
10

0 0
20

0
20

20

20

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1
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Reference Antiviral access
80% mask use

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 Pakistan

Figure 16.4: Reported daily COVID-19 deaths per 100,000

0.06

Daily deaths per 100,000

100
Daily deaths

0.04

50
0.02

0 0.00
20

0
20

20

20

20

21

1
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Fe

Ju

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Reference Antiviral access
80% mask use

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Figure 16.5: Total daily COVID-19 deaths per 100,000

3,000

Daily deaths per 100,000

1.0
2,000
Daily deaths

0.5
1,000

0 0.0
20

0
20

20

20

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Reference Antiviral access
80% mask use

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Figure 17.1: Comparison of reference model projections with other COVID modeling groups.
For this comparison, we are including projections of daily COVID-19 deaths from other modeling groups when
available, last model update in brackets: the SI-KJalpha model from the University of Southern California
(SIKJalpha) [December 5, 2022]. Regional values are aggregates from available locations in that region.

10.0

7.5
Daily deaths

Models
5.0 IHME (reported deaths)
SIKJalpha

2.5

0.0
23

23

3
2

r2
n

ar

Ap
Ja

Fe

Date

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 Pakistan

Figure 18.1: The estimated inpatient hospital usage is shown over time. The percent of hospital
beds occupied by COVID-19 patients is color-coded based on observed quantiles of the maximum proportion
of beds occupied by COVID-19 patients. Less than 5% is considered low stress, 5-9% is considered moderate
stress, 10-19% is considered high stress, and 20% or greater is considered extreme stress.

All hospital beds

Azad Jammu & Kashmir

Balochistan

Gilgit−Baltistan

Stress level
Low

Islamabad Capital Territory Moderate

High
Extreme

Khyber Pakhtunkhwa

Punjab

Sindh
M 20

Ju 0
Se 0
N 0

Ja 0
M 21
M 21

Ju 1
Se 1
N 1

Ja 1
M 22
M 22

Ju 2
Se 2
N 2

Ja 2
M 23
M 23
23
2
l2

2
2

2
l2

2
2

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l2

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2
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Figure 19.1: The estimated intensive care unit (ICU) usage is shown over time. The percent
of ICU beds occupied by COVID-19 patients is color-coded based on observed quantiles of the maximum
proportion of ICU beds occupied by COVID-19 patients. Less than 10% is considered low stress, 10-29% is
considered moderate stress, 30-59% is considered high stress, and 60% or greater is considered extreme stress.

Intensive care unit beds

Azad Jammu & Kashmir

Balochistan

Gilgit−Baltistan

Stress level
Low

Islamabad Capital Territory Moderate

High
Extreme

Khyber Pakhtunkhwa

Punjab

Sindh
M 20

Ju 0
Se 0
N 0

Ja 0
M 21
M 21

Ju 1
Se 1
N 1

Ja 1
M 22
M 22

Ju 2
Se 2
N 2

Ja 2
M 23
M 23
23
2
l2

2
2

2
l2

2
2

2
l2

2
2
ar
ay

p
ov

n
ar
ay

p
ov

n
ar
ay

p
ov

n
ar
ay
M

covid19.healthdata.org Institute for Health Metrics and Evaluation

 Pakistan

More information
Data sources:
Mask use and vaccine confidence data are from the The Delphi Group at Carnegie Mellon University and
University of Maryland COVID-19 Trends and Impact Surveys, in partnership with Facebook. Mask use data
are also from Premise, the Kaiser Family Foundation, and the YouGov COVID-19 Behaviour Tracker survey.
Genetic sequence and metadata are primarily from the GISAID Initiative. Further details available on the
COVID-19 model FAQ page.
A note of thanks:
We wish to warmly acknowledge the support of these and others who have made our COVID-19 estimation
efforts possible.
More information:
For all COVID-19 resources at IHME, visit http://www.healthdata.org/covid.
To download our most recent results, visit our Data downloads page.
Questions? Requests? Feedback? Please contact us at https://www.healthdata.org/covid/contact-us.

covid19.healthdata.org Institute for Health Metrics and Evaluation